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NPI Code Detail

MEDICARE: AILEEN GAIL VILLANUEVA OTR

MEDICARE: AILEEN GAIL VILLANUEVA OTR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist7991CA

General Provider Information

NPI Number : 1114055936
Entity Type Code : Individual
Provider Name (Legal Business Name) : AILEEN GAIL VILLANUEVA OTR
Provider Business Mailing Address
First Line : 2461 WAGNER ST
Second Line : UNIT 8
City : PASADENA
State : CA
Zip : 91107-2565
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5425 POMONA BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90022-1716
Country : US
Telephone Number : 323-728-0411
Fax Number : 323-890-8761
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2007
Last Update Date : 07/08/2007

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Directions to “ AILEEN GAIL VILLANUEVA OTR” Practice Location

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